For Pennsylvania’s aging prison population, a matter of life and death

Like so many older Pennsylvanians, Ezra Bozeman dealt with increasingly serious afflictions with each passing year. And like so many older Pennsylvanians, he struggled to get the health care he needed. Bozeman suffered from a spinal issue that was misdiagnosed for years until he had an MRI in 2023. He then underwent surgery to treat his injury but subsequently developed blood clots, which resulted in a second surgery. That operation left him paralyzed below the neck, rendering him unable to do the community-building and mentoring work he was devoted to in his later years.

Bozeman’s struggles to deal with the devastating consequences of inadequate health care reflect that of many of his peers – with one exception. He was subject to the machinations of the Pennsylvania Department of Corrections.

Boze – as Bozeman’s friends on the inside called him – spent nearly 50 of his 68 years of life in prison after being convicted at age 19 of killing Morris Weitz, the co-owner of a dry cleaner in Pittsburgh, in 1975 – a crime Bozeman maintained he did not commit. He became well-known for providing support and comfort to fellow inmates. Like many other individuals serving life sentences, he worked as a Certified Peer Support Specialist while at SCI-Chester, where he helped individuals navigate the challenges of incarceration. 

“The ‘old heads,’ as they call us, would be strategically placed all around the jail to stabilize prisons,” Lee Horton, an advocate for Families Against Mandatory Minimums, the nonprofit criminal justice reform organization, said. Horton, who was in prison with Bozeman, spends his days now calling into question the very system that kept seniors like Bozeman – who are often seen as valued mentors and difference-makers by both inmates and prison officials – incarcerated: “Why don’t you let them out and allow them to go back to those troubled communities and have that same effect out in society?” 

Bozeman’s May 2 request for compassionate release – the state’s narrowly defined law that determines if someone can be released early due to their physical condition, was granted on May 20. Unable to move without assistance and confined to a wheelchair, Bozeman was put on life support upon his release. On June 1, less than two weeks after leaving prison, he died at UPMC Altoona. 

Christine Roess, Bozeman’s fiancée, described him through tears as the “most incredible, mature, wonderful man … He had this real commitment to be love.”

Roess, the retired founder of a leadership development firm, met Bozeman through a friend and social worker in 2021 after Roess showed an interest in working with incarcerated individuals. From Zoom calls that progressed to in-person visits, Roess and Bozeman fell for each other, Roess bought herself an engagement ring and they began making plans together. 

Roess recalled how Bozeman’s motto to “Be love” turned into his “key to freedom,” he wrote in a letter to her – “a love that transcends walls and circumstances, a love that knows no bounds.”

Reflecting on the struggle to get him released, Roess said the system in place held him up “at every turn, at every juncture.”

“They say, ‘No one is above the law,’” she said, “but many are stuck under the boots of the law.”

The end-of-life struggle that faced Bozeman – one of Pennsylvania’s oldest and longest-serving prisoners – has become increasingly commonplace in the commonwealth’s prison system. Heading into 2024, there were more than 10,600 incarcerated people over the age of 50, accounting for more than 27% of the total prison population. The average age of an incarcerated individual is rising as well, jumping from 31 years old in 2000 to 38 years old in 2023, according to the Pennsylvania Department of Corrections. 

Rising demographics also mean rising costs: DOC spent $59,598 on average to house a person last fiscal year, according to department data. But the cost to taxpayers can skyrocket to more than $100,000 for an incarcerated person who needs regular medical attention. 

Average medication costs per person under the age of 50 is about $1,921, according to DOC, while for those individuals over age 50, it is $2,928. And nearly all of the incarcerated elderly population is on life-sustaining medication, driving overall medication costs to $40.5 million annually. 

As the commonwealth deals with an aging population, its aging inmates – one of the largest such groups in the nation – face a similar and harsher reality where adverse living conditions and lack of access to health care age them at a faster rate than those on the outside. 

Unless death is imminent, Pennsylvania has limited options for releasing aged inmates. Under state law, there are no parole opportunities for people serving life, even if they’re sick and determined to no longer be a danger to the public. 

One option – the one sought by Bozeman and his supporters – is compassionate release. The state’s compassionate release law covers incarcerated people who are seriously ill and expected to die within a year, but requirements are so narrow that fewer than 50 people have been granted such release in the last several years. 

Also known as deferment of sentence, compassionate release can be granted by a judge if the incarcerated individual is seriously or terminally ill, no longer able to walk, expected to live for less than one year, or in need of medical treatment better provided outside the prison facility. (If the individual’s condition improves, they would have to serve out the remainder of their sentence.) 

Since 2016, 83 compassionate release cases have been filed, according to the Department of Corrections. During that time – including two cases in 2024 that are still pending – 49 individuals were granted release; 13 individuals died while waiting for a hearing. 

Criminal justice advocates have long argued that the compassionate release standards are too restrictive, making cases like Bozeman’s difficult to process despite overwhelming support for his release. 

“Compassionate release restrictions are so narrow it’s almost impossible” for inmates and their advocates to successfully petition for such action, Celeste Trusty, Pennsylvania state policy director for Families Against Mandatory Minimums, explained.

The process also initially puts the onus on a physician to deem an individual terminally ill and expected to die within a year – a diagnosis many doctors are uncomfortable giving, Trusty said. 

“You have to look at the totality of their circumstances. You have to decide if society is better from their release or if they deserve perpetual punishment after already serving 20, 30, 40 and, in Ezra’s case, 50 years,” Trusty said. “It’s very frustrating for those serving mandatory life without parole because that doesn’t take into account how people mature and change. They also suffer from medical issues that would not be as bad – if they were treated in the community.”

One possible change would be to allow correctional and medical staff, not just incarcerated individuals’ loved ones, to initiate the compassionate release process. 

Wanda Bertram, of the nonprofit think tank Prison Policy Initiative, said expanding the process for compassionate release is “low-hanging fruit for policy reform” because it’s those around the incarcerated individuals, like correctional and medical staff, that best understand their needs. 

“If the people who are seeing them on a day-to-day basis had an ability, and even maybe a duty, to acknowledge and nominate them for compassionate release, that would get this process started a lot faster,” Bertram told City & State. 

Bozeman thought he had suffered a “mini-stroke” in 2019 and was dealing with hypertension and some neurological issues. It wasn’t until years later when doctors discovered the misdiagnosis and saw he had pinched nerves in his spine in 2022.

According to his medical release petition, Bozeman’s spinal compression went untreated for another year until he required emergency surgery at Temple University Hospital in early February. He made a nearly full recovery, according to medical records, but a lung clot discovered shortly after he returned from prison led to complications and, ultimately, quadriplegia.

Bozeman’s story brings to light the fraught, drawn-out process surrounding compassionate release and the existential needs of aging individuals incarcerated in state prisons. 

Horton said outside of the compassionate release process, there must be additional mechanisms for those serving long or life sentences, particularly those who were sentenced as juveniles, to have their cases reconsidered. 

“Some just have one unfortunate day in their life. That day, at a young age, sealed their fate for the rest of their life,” Horton said. “There are a lot of elderly men and women in prison in Pennsylvania who are deserving of a second chance. They deserved a second chance 25 years ago. They’ve become assets on the inside and we could allow them to come home to become assets out here.”

Determining a fair, just and humane solution to the issue seems to be gathering momentum among key politicians, including Gov. Josh Shapiro, who became the commonwealth’s first sitting governor to endorse the release of someone in state custody in the process when he supported the relief requested in Bozeman’s case. 

There also seems to be broad recognition among Harrisburg lawmakers that reforms are needed. Several legislative remedies were proposed this year, including one from state Sen. Sharif Street, who introduced a bill that would repeal the state’s current medical release provision and replace it with a law establishing more flexible parole opportunities based on age or illness.

Under his legislation, a medical provision could be granted to anyone with a terminal illness, a chronic and debilitating condition, serious functional or cognitive impairment, or deteriorating health due to age. A geriatric provision would also be created to allow anyone age 55 and older who has served the lesser of 25 years or half their sentence to apply for parole. But in both cases, the parole board would have to determine whether the person poses a danger to the public. 

State Sen. Lisa Baker, who chairs the Senate Judiciary Committee, has said she’s exploring a similar policy that would create a pilot program rather than a permanent change to the law. 

Bertram worries that many parole boards are hesitant to grant release regardless of circumstance. 

“The issue with parole boards a lot of time is that they simply have a bias against incarcerated people. They’re scared of them and they’re scared of, even more importantly, making a mistake and releasing somebody that goes on to commit another crime,” Bertram said, noting that a case review policy known as second-look sentencing, which would let incarcerated individuals serving long sentences petition their sentencing judge for a reduction of their sentence after serving a certain amount of time, has become popular in reform discussions. “Implementing something like second-look, where people automatically become eligible maybe 10 or 15 years into their sentence, that would be very powerful,” she said.

Trusty, who previously served as the commonwealth’s Secretary of the Pennsylvania Board of Pardons, said these measures would be a step in the right direction when it comes to having discretion in sentencing and relief after conviction. 

“These people want to heal the harm they’ve caused and repair the community,” she said. “How much is enough? And how much are taxpayers willing to spend on this system?”

“There’s no compassion in letting a man come home to die,” Horton said. “Compassion would be to allow someone who’s been in prison 30-something years and is in their late 50s, 60s or 70s who is no longer a threat to society to come home,” he noted. “After a while, it’s no longer punishment – it’s torture.”

Roess plans to launch the Christine and Ezra Bozeman Be Love Foundation to promote policy change, criminal justice reform efforts – and Bozeman’s story. 

“‘Be love’ was his central commitment,” she said. “So many people have been moved by that … Compassionate release is such an excruciating misnomer,” she said. “There is no compassion in the compassionate release process.”

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